Pos0783 Long Term Follow-Up of Children With Uveitis: Single-Centre Experience From North India

Background: Uveitis in children is a common cause of ophthalmological morbidity. The clinical phenotype, management protocols and long-term outcome varies depending on the aetiology and access to early initiation of therapy. Objectives: To report the clinical manifestations, management and follow-up of children with uveitis from a single centre cohort of patients from North India. Methods: A review of medical records of children with uveitis during the period January 1994 - November 2023 in Pediatric Rheumatology Clinic, Department of Pediatrics, Advanced Pediatrics Centre and the Retina Clinic, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India was done. Results: Of 310 children with uveitis, the most common infective aetiology was tubercular uveitis (n=25), followed by toxoplasmosis (n=1), toxocariasis (n=1) and staphylococcal sepsis (n=1). The non-infectious causes included juvenile idiopathic arthritis (JIA) (n=76), Blau syndrome (n=11), Behcet disease (n=7), Vogt-Koyanagi-Harada syndrome (n=4), sympathetic ophthalmitis (n=3) and miscellaneous causes (n=3). No identifiable cause was reported in 178 patients (idiopathic uveitis). Median age at diagnosis was 9 years (IQR: 6). Male: female ratio was 1.1:1. Bilateral involvement was noted in 228 patients. Most common type of uveitis was anterior (n=161), followed by panuveitis (n=76), isolated intermediate uveitis (n=42) and isolated posterior uveitis (n=31). Treatment protocols included topical corticosteroids and mydriatics in all patients and systemic corticosteroid in 233 patients [pulse methylprednisolone (n=20) and oral prednisolone (n=213)]. Other immunosuppressive drugs included methotrexate (n=221), azathioprine (n=60), mycophenolate mofetil (n=23), cyclosporin (n=9) and tacrolimus (n=3). Refractory disease was defined as no response to conventional disease modifying antirheumatic drugs. These patients were managed using adalimumab, infliximab, tocilizumab and tofacitinib (44, 6, 4 and 4 patients respectively). Of all patients, 139 (45%) developed eye complications at follow-up of 910 patient-years. Among these patients, 25 and 3 and moderate and severe vision impairment while 9 had blindness. Patients with multiple relapses (≥2) were more likely to develop poor vision (p=0.03) Conclusion: This is one of the largest single centre cohorts of pediatric uveitis in India. Idiopathic uveitis constitutes the majority of patients. Amongst the non-infectious causes, JIA is the most common while tubercular uveitis is the most common infective cause. Ophthalmological comorbidities were seen in more than 1/3rd of all patients. Delays in diagnosis and lack of access to biologics may be a significant cause of ocular morbidity in children with uveitis. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.